Why family planning cannot be only women's responsibility
The Covid-19 pandemic has thrown the world into deep turmoil. We cannot turn our back on the hard work in terms of survival, both health and economic, that we will all have to do to ensure our children and grandchildren inherit a better world. A central piece of this better world is to ensure the best use of limited resources on the ‘pale blue dot’, the only habitable planet we know of.
Smaller, better-planned families are central to being able to raise a more responsible generation, to enable both women and men to explore their lives to the fullest and rear families as an act of joy and not as a burden. Family planning or being able to decide the number of children women bear and space out births is central to any freedom that couples are likely to enjoy. As data from the Registrar General of India has revealed, India has shown a much-needed decline in Total Fertility Rates (TFR). Women are becoming increasingly conscious of their need to plan for themselves and their families, and this has led to this precipitous decline in TFR.
I invite you to consider what would happen and how much more India can do in this regard, if men too were more responsible and engaged in family planning matters, and took it upon themselves to undertake simple actions that would prevent unintended pregnancies.
The core of any successful family planning programme is the sharing of responsibilities between couples and the participation of men alongside women in shouldering the burden of contraception — where couples are equal participants in the responsibility and decision-making around contraceptive use.
Male engagement and participation in family planning are vital, especially as the facts and figures around it are so grim. There are two primary methods of contraception for men: the use of condoms, and vasectomy. Despite campaigns launched in the face of the HIV scare, condom use in India has actually declined by 52 per cent between 2008 and 2016, and vasectomies have fallen by 73 per cent. This suggests a greater and growing reluctance among men to use birth control. Female sterilisation (or tubectomy), a much more cumbersome and risky proposition, contributes to two-thirds of the overall modern contraceptive usage in India, as opposed to a paltry 0.3 per cent that vasectomy does!
According to the National Family and Health Survey (NFHS)-4 (2015-16) three in eight men believe that contraception is a ‘woman’s business’ and that men should not have to worry about it.
This is where government campaigns like the Vasectomy Fortnight event observed by the Ministry of Health and Family Welfare must be given a push by civil society organisations, and the Population Foundation of India is committed to continuing to do just that. We aim to create awareness, bust myths around vasectomy, and engage youngsters on topics of vasectomy and male participation. Video interviews with clients who have undergone the procedure, community mobilisers, service providers and counsellors, who are proactively engaged in the provision of vasectomy and can share grassroots realities, have been planned. Interviews with doctors specialising in the Non-Scalpel Vasectomy technique, from various parts of India will be shared. These will include their experiences as well as observations of the trends they have witnessed in male sterilisation since NSV was introduced in 1992. We also hope to share interviews with government officials on the challenges and opportunities they see in their districts, so specific problems can be tackled.
But as we all know, this has to go beyond just marking a week and we need a much longer and deeper exercise, one that is aimed at an attitudinal shift among our women and men, where they learn to share both rights and responsibilities.
Despite efforts in the past, mistaken notions of masculinity have led to a regression in attitudes and approaches towards this risk-free, modern, safe, simple and reversible method of family planning. A study on masculinity has revealed that 54 per cent of the men who were questioned, stated that their wives could not use contraception without their permission and 20 per cent of them said that avoiding pregnancy is a woman’s responsibility. What was of even greater concern is that a higher percentage of women, 31 per cent, concurred.
The discourse on the engagement of men as partners in family planning will succeed only if it goes beyond contraceptive use and addresses false but persistent myths around how vasectomy impacts men. Also, when we advocate male participation, it must be about being responsible and respecting equality rather than just about decision-making. It should extend to the role of men as enablers and beneficiaries in the process of ensuring dignity, equal voice, and reproductive rights for women. Male participation should not mean that women are forced to accept the choices men make. We must therefore handle the question of male participation sensitively, as studies reveal that men often think participation is about control and want to make contraception decisions unilaterally, often deciding about contraception of female partners. Particularly in the context of the prevalence of intimate partner violence, this can impede contraceptive use as well as increase risk for contraceptive failure.
We believe that the public health system, family planning programmes and communication strategies should be designed to encourage male engagement in family planning. There should be an emphasis on changing mindsets and stereotypes so as to enable women to make decisions regarding their own health and increasing spousal communication.
Population Foundation of India believes that all attempts to achieve our crucial goal of population stabilisation, which will be the bedrock of the success of all of India’s development goals can be met through the empowerment of women and young people, enabling them to make right choices that are good for them and also good for their partners, communities and the country.
We have addressed the need to advocate for men to accept vasectomy as a family planning method through our popular transmedia serial, Main Kuch Bhi Kar Sakti Hoon. An end-line evaluation, which was conducted by an independent agency, showed that after watching the serial, women had become more confident in communicating with their husbands on contraception and accessing family planning services. A group of men from Chhatarpur in Madhya Pradesh pledged to adopt contraception after watching this powerful serial. They advocate for adoption of vasectomy – termed as ‘mastbandi’ (a modification of the phrase ‘nasbandi’) in the serial and move from village to village in the region and sing ballads to motivate other men.
The way forward has to be collaborative and given male sensitivity on the subject, we would do well to extend the same courtesies extended to women when we advocate safe reproductive choices for them, to men too. With persuasion, good and accurate information on the benefits of sharing responsibilities and the right nudge, both women and men must be enabled to embrace better possibilities and so, a better world.